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NPI Code Detail

MEDICARE: NIDHIN SAMUEL

MEDICARE: NIDHIN SAMUEL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerF403257-01NY

General Provider Information

NPI Number : 1306518915
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIDHIN SAMUEL
Provider Business Mailing Address
First Line : 1 LONG BEACH RD
Second Line :
City : ISLAND PARK
State : NY
Zip : 11558-2254
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1 LONG BEACH RD
Second Line :
City : ISLAND PARK
State : NY
Zip : 11558-2254
Country : US
Telephone Number : 516-432-0300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2021
Last Update Date : 12/14/2021

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Directions to “ NIDHIN SAMUEL ” Practice Location

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